title: Essential components of an infection prevention program for outpatient hemodialysis centers.
abstract: Infections are a significant complication for dialysis patients. The CDC estimates that 37,000 central line-related bloodstream infections occurred in hemodialysis patients in 2008 and dialysis-associated outbreaks of hepatitis C continue to be reported. While established hospital-based infection prevention programs have existed since the 1970s, few dialysis facilities have an established in-center program, unless the dialysis facility is hospital-associated. This review focuses on essential core components required for an effective infection prevention program, extrapolating from acute-care programs and building on current dialysis guidelines and recommendations. An effective infection prevention program requires infrastructure, including leaders who place infection prevention as a top priority, active involvement from a multidisciplinary team, surveillance of outcomes and processes with feedback, staff and patient education, and consistent use of evidence-based practices. The program must be integrated into the existing Quality Assessment and Performance Improvement program. Best practice recommendations for the prevention of infection, specific to dialysis, continue to evolve as the epidemiology of dialysis-associated infections is further researched and new evidence is gathered. A review of case studies illustrates that with an effective program in place, infection prevention becomes part of the culture, reduces infection risk, and improves patient safety.
authors.affiliation: James M. Jeffords Institute for Quality and Operational Effectiveness, Fletcher Allen Health Care, Burlington, VT 05401, USA. sally.hess@vtmednet.org
authors.forename: Sally
authors.initials: S
authors.lastname: Hess
authors.forename: Virginia
authors.initials: V
authors.lastname: Bren
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration* / Q000592:standards; D001424:Bacterial Infections / Q000517:prevention & control; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D003428:Cross Infection / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D011786:Quality Control; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D062666:Vascular Access Devices / Q000009:adverse effects / Q000382:microbiology